Speaker: Teodor Horvath, M.D.
Topic: History of NITS
Institutions: Department of Surgery Faculty Hospital Brno, Masaryk University Faculty of
Medicine; CBC Vznik Initiative THORaxUN
Discern current relations
familiar with days of yore
Overview of the development leading to minimally-invasive physiological operations by anatomical pulmonary resection using regional anesthesia and targeted sedation with spontaneous ventilation.
When delving into the literature affected by the long-established practice of intubation, we are more than a little surprised to find that the history of thoracic surgery developed in two parallel, mutually penetrating lines – intubated and non-intubated methods.
Non-intubated thoracic surgery aims to reach harmony with the findings of physiology. It is physiological surgery in the meaning of this original Czech idea in a new – thoracic – field. It is interesting from a health, professional, operational and economic viewpoint. A look into the past shows the development and viability of NITS in various conditions. It is up to the global community to deal with every detail of its validity. The more you know, the less you need.
Speaker: Tsung-An, Tsai, M.D.
Topic: History Non-intubated Thoracic Surgery (NITS) - Regional and General Anesthesia
Institution: National Taiwan University Hospital Departmenf of Anesthesiology
Historically, prior to the development of double lumen tubes in the 1950s, thoracic procedures were performed awake under local or regional anesthesia. This, however, carried a high mortality and morbidity rate. It became a standard approach to isolate the operative lung using a double lumen endotracheal tube or single lumen endotracheal tube and endobronchial blocker combined with a general anesthetic (GA).
Over the last decade, there has been a huge evolution in thoracic surgery with the development minimally invasive techniques. Similarly, less conventional thoracic anesthesia strategies have evolved to encompass less invasive surgical techniques.
There is a growing interest in non-intubated techniques during which thoracic surgery is performed on patients who are spontaneously ventilating awake, under minimal sedation with the aid of local or regional anesthesia or under general anesthesia with a supraglottic airway device.
GA could be maintained using volatile anesthesia or total intravenous target controlled anesthesia usually with propofol and remifentanil. A bispectral index sensor (BIS) was applied to monitor the level of consciousness. The level of sedation was set to achieve a BIS value between 40 and 60.
Regional anesthesia was achieved by thoracic epidural anesthesia, paravertebral blocks (PVB), intercostal nerve blocks (ICNB) and serratus anterior block. For cough control, inhalation of aerosolized lidocaine, lidocaine spray, ipsilateral stellate ganglion block and vagal nerve blockade were applied.
With a well-controlled, well-monitored anesthetic combinations of regional anesthesia, sedation, and postoperative pain service, NITS has been proved to be safe and feasible amongst a wide variety of patient groups.